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Pick-Up Request Form

Before requesting a pick-up, review these policies:

  • Only University-owned Equipment can be recycled through this program.
  • The information on this form is used determine the personnel and equipment needed for pick-up. If the information provided is incomplete or inaccurate, your pick-up may need to be rescheduled.
  • Accounting Services for Research and Sponsored Programs (ASRSP) must approve recycling of any equipment acquired using federal funds. Read more about ASRSP disposal policies.
  • Report equipment with inventory tags (or cost exceeding $5,000) to Accounting Services by completing the online disposal form in the asset management self-service portal. For questions about the self-service portal or other Accounting Services policies on capital equipment disposal, please contact the Property Accountant at equipment-disposal@northwestern.edu.
  • Place all keyboards, mice, small peripherals, etc. into a box for pick-up.
  • Do not cut any computer or power cords prior to pick-up.

Name *

Department *

Address *

Campus *

Campus Phone Number *

E-mail Address *

Backup Contact Name (in case main contact is unavailable during pick-up)

Backup Contact Campus Phone Number

Quantity of all items to be picked up:
CPU Server Laptop

Small (up to 15") CRT Monitor

Medium (16" - 19") CRPT Monitor

Large (20”+) CRT Monitor

Small (up to 15”) Flat Screen Monitor

Medium (16”-19”) Flat Screen Monitor

Large (20”+) Flat Screen Monitor

Small (up to 19”) Television

Medium (20”-29”) Television

Large (30”+) Television

Peripherals (mouse, keyboard, speakers)

Small Printer Medium Printer Large Printer

Does the printer have a hard drive? Yes No Don't Know

Scanner

Data storage devices (hard drive, zip drive, CD drive, etc.) for shredding Box all items.

Battery Backups Overhead Projectors

Other:

Delivery considerations:
Identify any heavy or oversized items and their approximate weight.

Identify location considerations:

Elevator Yes No - Number of stairs from location to ground level (4-6, 7-10):

I have complied with University Policy and have received ASRSP approval for equipment acquired using federal funds and notified Accounting Services (by reporting in the asset management self-service portal) of any equipment being disposed of with inventory tags or cost exceeding $5,000.

Pick-up Location (if different from Department Address):

* = required

You will be sent an email confirming pick-up time and date as well as a form to be completed when the items are picked up.